Del Rosa Villa - San Bernardino Nursing Home
General Information
UPDATEFederal Provider Number
555195
Provider Name
DEL ROSA VILLA
Provider Address
2018 N DEL ROSA AVE.
SAN BERNARDINO, CA 92404
SAN BERNARDINO, CA 92404
Provider Phone Number
9098853261
Provider SSA County
460
Provider County Name
San Bernardino
Ownership Type
For profit - Corporation
Number of Certified Beds
104
Number of Residents in Certified Beds
96
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DEL ROSA VILLA, LLC
Date First Approved to Provide Medicare and Medicaid services
1984-09-10
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.45365
Reported LPN Staffing Hours per Resident per Day
0.93438
Reported RN Staffing Hours per Resident per Day
0.44688
Reported Licensed Staffing Hours per Resident per Day
1.38125
Reported Total Nurse Staffing Hours per Resident per Day
3.83491
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08281
Expected CNA Staffing Hours per Resident per Day
2.48877
Expected LPN Staffing Hours per Resident per Day
0.71344
Expected RN Staffing Hours per Resident per Day
1.08667
Expected Total Nurse Staffing Hours per Resident per Day
4.28888
Adjusted CNA Staffing Hours per Resident per Day
2.41908
Adjusted LPN Staffing Hours per Resident per Day
1.08704
Adjusted RN Staffing Hours per Resident per Day
0.30728
Adjusted Total Nurse Staffing Hours per Resident per Day
3.60424
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
84
Cycle 1 Standard Survey Health Date
2015-03-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
84
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
189
Cycle 2 Standard Health Survey Date
2014-04-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
17
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
116
Cycle 3 Standard Health Survey Date
2013-05-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
116
Total Weighted Health Survey Score
124.33300
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
6
Number of Fines
1
Total Amount of Fines in Dollars
29160
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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